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SAN FRANCISCO — San Francisco on Monday became the only city in the nation to pay for its employees to receive sex changes, after the Board of Supervisors narrowly passed the measure.

“It is landmark legislation,” said Supervisor Mark Leno, who has worked about two years to have the benefits added. “This is not like losing one’s hair. It’s not like displeasure with the size and shape of one’s nose.”

An audience filled with transgenders and supporters wearing florescent green and pink stickers that read “Transgender Equality” leaped into the air and cheered following the 9-2 roll call. The measure needed nine votes to pass. Supervisors Tony Hall and Leland Yee were the two opposing supervisors on the 11-member board.

The measure, which awaits the signature of Mayor Willie Brown, will extend up to a $50,000 lifetime cap in benefits to city workers who want to switch their gender.

San Francisco apparently would be the only governmental body in the nation to make such benefits available. The state of Minnesota offered similar benefits, but the program was phased out in 1998. The issue was discussed in Oregon, but a commission decided against it in 1999.

“This is just one step against discrimination,” said Theresa Sparks, a transgender commissioner at the city Human Rights Commission. “This is the first step, and it’s an important step. I look forward to working with Supervisor Hall.”

Hall, who has spoken against the benefits, received countless e-mails and phone calls from the transgender community following his public opposition at a meeting last week. The benefits were scheduled to go to a vote then. The vote was postponed because of Hall’s opposition plus the absence of two supervisors, which would have left the proposal one vote shy of the necessary nine.

“All of us were born with problems,” Hall said. “This is not society’s problem, and to think otherwise is to discriminate.”

Hall argued the city’s benefits are meant to cover procedures that are medically necessary. He considers gender reconstruction surgery elective and said the city should not pay for transgender benefits without extending the same coverage to those who suffer from obesity, anorexia and learning disabilities.

“Once again, the city and county of San Francisco is paying for something that is not necessary,” Hall said following the vote. “I suspect there will be hidden costs that were not revealed in today’s debate.”

Leno stressed the insurance would not cover cosmetic procedures. It instead would pay for genital reconstruction, hormones and other medical matters such as hysterectomies and mastectomies only after a doctor deems it medically necessary.

The city currently has 14 identified transgender employees out of its 37,000 workers.

The insurance changes that would cost $1.70 a month would include items such as infertility drugs, Viagra and acupuncture, in addition to the sex-change benefits.

The benefits would be available starting July 1 and would cover male-to-female surgery, which costs about $37,000, as well as female-to-male surgery, which runs about $77,000. It also would cover hormones and other procedures.

Employees would have to work for the city at least one year before they would be eligible. People wanting sex-change surgery would have to pay 15 percent out of pocket if they use a doctor in the city’s health network. If an out-of-network doctor is used, that goes up to 50 percent.

The term transgender covers a broad range of categories including cross-dressers, transvestites, transsexuals and those born with characteristics of both sexes.

Veronika Cauley, a transgender commissioner on the city’s Veterans Affairs Commission, said she’s more interested in electrolysis and breast augmentation and isn’t sure what city benefits she will use. But she’s thrilled to know she now has the option.

“I am who I am. I just have a gender dysphoria issue,” she said. “It’s all about R-E-S-P-E-C-T.”